title: Limberg skin flap for treatment of necrosis and bleeding at haemodialysis arteriovenous angioaccess puncture sites.
abstract: OBJECTIVE
  To assess the efficacy of a Limberg skin flap to treat non-infected necrosis and bleeding at angioaccess puncture sites.
  
  
  METHODS
  Retrospective analysis of 40 selected (no infection, necrosis <20 mm diameter) patients (25 arteriovenous fistulae [AVF], 15 grafts) treated between 1998 and 2012 by rhomboid excision, vessel repair, and a locally rotated full-thickness Limberg skin flap together with early postoperative percutaneous transluminal angioplasty (PTA; n = 23/40). Success was defined as wound healing and angioaccess patency without complications.
  
  
  RESULTS
  Success rates at 1 and 6 months were 96% (24/25) and 76% (19/25), respectively, for AVF, and 80% (12/15) and 40% (6/15) for arteriovenous grafts. Complications included flap necrosis (n = 2), graft thrombosis (n = 4), minor sepsis (n = 1), death (n = 2), and new puncture site necrosis (n = 3). Four patients were lost to follow-up.
  
  
  CONCLUSIONS
  Vessel or graft repair, PTA for distal stenoses and local debridement followed by a Limberg skin flap for tissue defects prevented further bleeding and maintained vascular access patency in 25/40 (62%) patients.
authors.affiliation: University Sapienza, Department of Clinical and Molecular Science, Rome, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Pirozzi
authors.forename: L
authors.initials: L
authors.lastname: Pettorini
authors.forename: J
authors.initials: J
authors.lastname: Scrivano
authors.forename: P
authors.initials: P
authors.lastname: Menè
authors.forename: L
authors.initials: L
authors.lastname: Karam
authors.forename: P
authors.initials: P
authors.lastname: Bourquelot
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000098:blood supply / Q000601:surgery; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011183:Postoperative Complications; D011677:Punctures; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014654:Vascular Patency; D014945:Wound Healing
keywords: Angioaccess; Arteriovenous; Bleeding; Cannulation; Haemodialysis; Limberg; Necrosis; Skin flap